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GOUT Arthritis and Diet

Excessive levels of uric acid in the blood (hyperuricemia) are risk factors for gout attacks, which are generally defined as uric acid levels> 6.8 mg/dl (404 ┬Ámol / L).

Various factors can affect blood uric acid levels, namely excessive production, for example, due to high purine diets, as well as due to lack of excretion, for example, due to consumption of diuretics, kidney failure, and genetic defects.

A low purine diet is considered to be able to reduce blood uric acid levels, so it is used in preventing and treating gout. Gout arthritis results from deposits of uric acid crystals in the joints that trigger an inflammatory response.

GOUT Arthritis and Diet
A Patient is getting pain of gout
Image Source: https://www.thesun.co.uk


Association between Diet and Gout

Several food factors have been linked to the incidence of gout through observational studies. There is scientific evidence that the consumption of alcohol, sweetened drinks, meat, seafood, and high-fructose foods has a positive association with gout.

Meanwhile, consumption of dairy products, coffee, and micronutrients has been associated with lower incidences of gout and gout flare. However, many of these studies have a high risk of bias, such as recall bias, and also cannot determine the causative relationship between diet and gout.


Purine Intake and Gout Risk

A study by Zhang et al., Involving 633 study subjects, tried to evaluate the relationship between purine intake and the risk of gout recurrence. The study found that a high intake of purines would increase the recurrence of gout by five times. They concluded that avoiding or reducing high purine food intake, especially from animal sources, can reduce the risk of gout attacks.

The Purine Content in Food
Nuts, soy products, and average cereals contain ≤50 mg / 100 g of purine. Dried soybeans contain more purines than other nuts, which is 172.5 mg / 100 g. Tofu, soy milk, and other processed soy products contain ≤50 mg / 100 g of purine.

Meanwhile, eggs and most dairy products contain almost no purine or ≤13 mg / 100 g. Most mushrooms also contain low levels of purines, ranging from 6.9 to 98.5 mg / 100 g. Bananas and strawberries also have low purine levels of 2-3 mg / 100g.

About 70% of vegetables have a purine level of ≤50 mg / 100 g. Vegetables with moderate to high purine content are parsley and spinach. On the other hand, 60% of meat has a purine content of ≥100 mg / 100g. Chicken liver has a very high purine content, which is 312.2 mg / 100 g. Meanwhile, beef liver contains 219.8 mg / 100 g of purine, and pork liver contains 284.8 mg / 100 g of purine. The purine content in processed meat ranges from 45.5-138.3 mg / 100 g, with the highest content in prosciutto and salami.

Just like meat, most fish contain ≥100 mg / 100 g of purine. Some examples of seafood with high purine content are sardines, bonito, gnomefish, and small shrimp (krill).


Diet Program to Prevent Gout

A cross-sectional study of 2076 healthy subjects found that dairy products, calcium, lactose, and sweetened drinks significantly increased uric acid levels. However, consumption of high purine vegetables and fructose intake with measured calories were found to be unrelated to plasma uric acid levels. This study concludes that limiting the consumption of high purine vegetables is not effective in reducing uric acid levels.

A systematic review states that consumption of high-purine foods sourced from animals and seafood is crucial in increasing uric acid levels. Meanwhile, foods high in purines from vegetables, do not cause significantly similar effects. This study also reports that vitamin C consumption can increase uric acid excretion so that it can be used as a supplement for gout management. It also said that consuming foods rich in vitamin C, oils from plants such as olive oil, sunflower oil, and soy could reduce the risk of hyperuricemia and gout.


DASH Diet for Gout

A prospective cohort study shows that dietary patterns based on Dietary Approaches to Stop Hypertension (DASH) are associated with significantly lower gout risk. In contrast, Western dietary patterns (high intake of red meat, processed meat, sweetened foods, french fries, and refined grains) are associated with a 1.42-fold increased risk of gout. This study concluded that the DASH diet had a good effect in reducing uric acid levels in hyperuricemia patients to prevent gout.

The DASH diet is a combination of low sodium (<300 mg / day), high potassium (4700 mg / day), magnesium (> 420 mg / day), calcium (> 1000 mg / day), and fiber (25- 30 g / day), and low in saturated fatty acids and cholesterol (<200 mg / day). In this diet, it is recommended to use fresh, natural, and not through industrial processes.

The DASH diet emphasizes more fruit-vegetable intake to achieve 30 g of fiber a day for a 2100 calorie meal plan per day, low in dairy products, and low in saturated fat. The recommended daily calories in the DASH diet come from 55% carbohydrates, 18% protein, 27% fat, and not more than 6% saturated fat.

Conclusion
Existing observational studies show that consumption of animal-based foods, dairy products, and drinks containing sweeteners can increase the risk of hyperuricemia and gout. Meanwhile, plant-based diets, including high purine plants, do not increase uric acid levels and gout risk. A recent study shows that the DASH dietary pattern, which is commonly used for hypertensive patients, also has benefits in preventing the incidence of gout.

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2 Comments

  1. My friend has been suffering from gout for a long time. but I see he doesn't seem to care about food intake. in short he eats anything... and this, gives an impact to his work performance

    ReplyDelete
  2. Hello Kakak Anies, welcome to my blog.

    sarankan saja, kawan kakak anies untuk berkunjung blog saya, agar tambah ilmu dan boleh memberi terapi untuk gout yang dideritanya.

    Salam untuk blogger Malaysia

    ReplyDelete